Comparison between anterolateral thigh, radial forearm, and peroneal artery flap donor site thickness in <scp>A</scp>sian patients—A sonographic study

Hsu, Kuei‐Chang; Tsai, Wei Hsuan; Ting, Pei San; Hsueh, Jung Hua; Chen, Lee Wei; Lin, Ying Sheng

doi:10.1002/micr.30164

Cited by 26 publications

(32 citation statements)

References 37 publications

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“…Similar to our study, earlier studies have also demonstrated thicker subcutaneous fat in the anterior thigh region in female patients than in male patients [8,11,12,13], and also the ALT flap thickness has been correlated with BMI [8,11,13,14]. In the present study, we have demonstrated for the first time that there exists a correlation between flap thickness and BMI and gender in all thigh flaps studied, including the PAP flap.…”

Section: Discussionsupporting

confidence: 91%

“…Aladimi et al [7] reported a mean thickness of 14.5 ± 4.2 mm for the ALT flap; this relatively high value was probably because the volunteers in their study were all healthy and Americans. Hsu et al [8] reported a lower mean thickness of 9.8 ± 4 mm in 202 healthy volunteers from Taiwan. These data from Doppler ultrasound studies suggest that the flap thickness varies with ethnic origin and health status and it appears to be less in Asian patients than in Westerners.…”

Section: Discussionmentioning

confidence: 98%

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Comprehensive Analysis of Profunda Artery Perforator Flap Thickness Based on CTA

Heredero¹,

Falguera²,

Sanjuan³

et al. 2019

IMJ

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Soft tissue microsurgical reconstruction in the head and neck regions can be performed with different types of free flaps. For decades, the anterolateral and anteromedial thigh regions have been considered as the ideal donor sites [1,2], especially in Asian countries. Recently, the profunda artery perforator (PAP) flap harvested from the posteromedial region of the thigh has been proposed as a good choice for use in oral cavity reconstruction [3,4,5]. However, in the Western countries, thigh flaps, especially the PAP flaps, are not used as often as in the Asian countries for oral reconstruction because there are concerns regarding the greater thickness of thigh flaps as compared with the radial forearm free flaps (RFFF). There are previous publications on anterolateral thigh (ALT) flap thickness measured with Doppler ultrasound [6,7] and only one study using computed tomographic angiography (CTA) [8]. However, none of these studies compare ALT flap thickness with PAP flap thickness in the same patient. The aim of this study was to compare the PAP flap thickness with the thickness of other thigh flaps that were more commonly used for intraoral reconstruction and to identify the factors influencing its thickness in our population using CTA. This information would be useful to facilitate flap selection based on desired tissue volume in patients with greater thigh thickness, like our population. MATERIAL AND METHODS Study Sample The study sample comprised 72 legs of 36 patients. The inclusion criteria were the patients who underwent head and neck microsurgical reconstruction with a fibula free flap and a preoperative CTA. The exclusion criteria consisted of the antecedent of previous thigh flap harvested. CTA was performed on a 64-slice multiple detector computed tomography scanner (LightSpeed VCT; GE Healthcare, Milwaukee, WI, USA) using a standardized protocol. Data post-processing was done using the open-source software Horos TM v 1.1.7 (GNU Lesser General Public License, version 3). Morphologic analysis of flap thickness and perforator location was done for the ALT flap, the anteromedial (AMT) flap, the distal superficial femoral artery perforator (d-SFAP) flap, and the PAP flap in all 72 legs. The d-SFAP flap is not commonly used for intraoral reconstruction, but it was also included in this study because of the constancy of the location of its perforator. For the ALT flap, the references were the anterior superior iliac spine (ASIS) and the superolateral border of the patella. The best perforator around the midpoint between both references was identified and its location relative to the ASIS was registered. The same references were used for the AMT flap. The cutaneous perforator of the AMT flap was located close to the intersection between the rectus femoris and sartorius muscles. The perforator's location (relative to the ASIS) and its origin-whether arising from the lateral circumflex femoral artery (LCFA), medial circumflex femoral artery (MCFA), or superficial femoral artery (SFA)-were identified. For the P...

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 98%

Comprehensive Analysis of Profunda Artery Perforator Flap Thickness Based on CTA

Heredero¹,

Falguera²,

Sanjuan³

et al. 2019

IMJ

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“…Because multiple perforators could be usually found in the lateral lower leg, a double‐paddle peroneal flap could be easily harvested (Yang et al, ). With its relative thinness compared to antero‐lateral thigh flap (Hsu et al, ), the peroneal flaps could be easily reshaped into desirable shapes, such as acute‐angle mouth angle (Liu & Yang, ), hemiglossectomy defect (Lin, Liu, Lin, Chen, & Yang, ), hypopharyngeal defect (Lin et al, ), or extensive lip reconstruction (Lin, Liu, Lin, Chen, Hsueh et al, ). The novelty of this report is that we refine our design to maximize the area of skin paddle we could harvest.…”

Section: Discussionmentioning

confidence: 99%

Obliquely‐arranged double skin paddles: A novel design to reconstruct extensive head and neck defects with a single fibula or peroneal flap

et al. 2018

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“…Flap thickness is thinner than that of ALT flaps (6.32 mm vs. 9.8 mm). Though LAFF is reported to be thicker than RFFF (6.32 mm vs. 2.8 mm), our experience reveals that extremely thin septocutaneous flaps can be harvested through a more lateral epicondyle oriented approach than conventional one [18,20,21]. It was especially useful for tongue tip reconstruction where thin pliable flap characteristics play bigger roles in shaping the delicate dimension of the tip, providing more functional tongue mobility.…”

Section: Discussionmentioning

confidence: 89%

Exclusive tongue tip reconstruction of hemiglossectomy defects using the underrated lateral arm free flap with bilobed design

Oh¹,

Lee²,

Lee³

et al. 2019

Arch Craniofac Surg

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BackgroundTongue reconstruction is challenging with the unique function and anatomy. Goals for reconstruction differ depending on the extent of reconstruction. Thin and pliable flaps are useful for tongue tip reconstruction, for appearance and mobility. This study reports lateral arm free flap (LAFF) as a safe and optimal option for hemi-tongue reconstruction, especially for tongue tip after hemiglossectomy.MethodsThirteen LAFFs were performed for hemi-tongue reconstruction after hemiglossectomy from 1995 to 2018. Of the 13 patients, seven were male and six were female, age varying from 24 to 64 years.ResultsAll flaps healed uneventfully without complications. Donor sites were closed primarily. The recipient vessels for microvascular anastomosis were mainly superior thyroidal artery, external jugular vein. All patients returned to normal diet, with no complaints regarding reconstructed tongue and donor site.ConclusionThe LAFF is hairless, thin (especially with lateral epicondyle approach), and potentially sensate. They are advantageous features for tongue tip and hemi-tongue reconstruction. Donor site sacrifices the inessential posterior radial collateral artery, and the scar is hidden under short sleeve shirts. We believe that LAFF can be considered as the first choice flap for hemitongue reconstruction, over radial forearm free flaps.

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Comparison between anterolateral thigh, radial forearm, and peroneal artery flap donor site thickness in Asian patients—A sonographic study

Cited by 26 publications

References 37 publications

Comprehensive Analysis of Profunda Artery Perforator Flap Thickness Based on CTA

Comprehensive Analysis of Profunda Artery Perforator Flap Thickness Based on CTA

Obliquely‐arranged double skin paddles: A novel design to reconstruct extensive head and neck defects with a single fibula or peroneal flap

Exclusive tongue tip reconstruction of hemiglossectomy defects using the underrated lateral arm free flap with bilobed design

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